1. An older adult is newly diagnosed with primary hypertension and
has just been started on a beta-blocker. The nurse’s health education
should include which of the following?
A) Increasing fluids to
avoid extracellular volume depletion from the diuretic effect of the
beta-blocker
B) Maintaining a diet high in dairy to increase
protein necessary to prevent organ damage
C) Use of strategies to
prevent falls stemming from postural hypotension
D) Limiting
exercise to avoid injury that can be caused by increased intracranial pressure
Ans: C
Feedback:
Elderly people have impaired
cardiovascular reflexes and are more sensitive to postural
hypotension. The nurse teaches patients to change positions slowly
when moving from lying or sitting positions to a standing position,
and counsels elderly patients to use supportive devices as necessary
to prevent falls that could result from dizziness. Lifestyle changes,
such as regular physical activity/exercise, and a diet rich in fruits,
vegetables, and low-fat dairy products, is strongly recommended.
Increasing fluids in elderly patients may be contraindicated due to
cardiovascular disease. Increased intracranial pressure is not a risk
and activity should not normally be limited.
2. A patient with primary hypertension comes to the clinic
complaining of a gradual onset of blurry vision and decreased visual
acuity over the past several weeks. The nurse is aware that these
symptoms could be indicative of what?
A) Retinal blood vessel
damage
B) Glaucoma
C) Cranial nerve damage
D)
Hypertensive emergency
Ans: A
Feedback:
Blurred vision, spots in front of the
eyes, and diminished visual acuity can mean retinal blood vessel
damage indicative of damage elsewhere in the vascular system as a
result of hypertension. Glaucoma and cranial nerve damage do not
normally cause these symptoms. A hypertensive emergency would have a
more rapid onset.
3. A nurse is performing blood pressure screenings at a local health
fair. While obtaining subjective assessment data from a patient with
hypertension, the nurse learns that the patient has a family history
of hypertension and she herself has high cholesterol and lipid levels.
The patient says she smokes one pack of cigarettes daily and drinks
about a pack of beer every day. The nurse notes what nonmodifiable
risk factor for hypertension?
A) Hyperlipidemia
B) Excessive
alcohol intake
C) A family history of hypertension
D) Closer
adherence to medical regimen
Ans: C
Feedback:
Unlike cholesterol levels, alcohol
intake and adherence to treatment, family history is not modifiable.
4. The staff educator is teaching ED nurses about hypertensive
crisis. The nurse educator should explain that hypertensive urgency
differs from hypertensive emergency in what way?
A) The BP is
always higher in a hypertensive emergency.
B) Vigilant
hemodynamic monitoring is required during treatment of hypertensive
emergencies.
C) Hypertensive urgency is treated with rest and
benzodiazepines to lower BP.
D) Hypertensive emergencies are
associated with evidence of target organ damage.
Ans: D
Feedback:
Hypertensive emergencies are acute,
life-threatening BP elevations that require prompt treatment in an
intensive care setting because of the serious target organ damage that
may occur. Blood pressures are extremely elevated in both urgency and
emergencies, but there is no evidence of target organ damage in
hypertensive urgency. Extremely close hemodynamic monitoring of the
patient’s BP is required in both situations. The medications of choice
in hypertensive emergencies are those with an immediate effect, such
as IV vasodilators. Oral doses of fast-acting agents, such as
beta-adrenergic blocking agents, angiotensin-converting enzyme
inhibitors, or alpha-agonists, are recommended for the treatment of
hypertensive urgencies.
5. A group of student nurses are practicing taking blood pressure. A
56-year-old male student has a blood pressure reading of 146/96 mm Hg.
Upon hearing the reading, he exclaims, “My pressure has never been
this high. Do you think my doctor will prescribe medication to reduce
it?” Which of the following responses by the nursing instructor would
be best?
A) “Yes. Hypertension is prevalent among men; it is
fortunate we caught this during your routine examination.”
B) “We
will need to reevaluate your blood pressure because your age places
you at high risk for hypertension.”
C) “A single elevated blood
pressure does not confirm hypertension. You will need to have your
blood pressure reassessed several times before a diagnosis can be
made.”
D) “You have no need to worry. Your pressure is probably
elevated because you are being tested.”
Ans: C
Feedback:
Hypertension is confirmed by two or more
readings with systolic pressure of at least 140 mm Hg and diastolic
pressure of at least 90 mm Hg. An age of 56 does not constitute a risk
factor in and of itself. The nurse should not tell the student that
there is no need to worry.
6. A 40-year-old male newly diagnosed with hypertension is discussing
risk factors with the nurse. The nurse talks about lifestyle changes
with the patient and advises that the patient should avoid tobacco
use. What is the primary rationale behind that advice to the
patient?
A) Quitting smoking will cause the patient’s
hypertension to resolve.
B) Tobacco use increases the patient’s
concurrent risk of heart disease.
C) Tobacco use is associated
with a sedentary lifestyle.
D) Tobacco use causes ventricular hypertrophy.
Ans: B
Feedback:
Smoking increases the risk for heart
disease, for which a patient with hypertension is already at an
increased risk. Quitting will not necessarily cause hypertension to
resolve and smoking does not directly cause ventricular hypertrophy.
The association with a sedentary lifestyle is true, but this is not
the main rationale for the nurse’s advice; the association with heart
disease is more salient.
7. A patient has been prescribed antihypertensives. After assessment
and analysis, the nurse has identified a nursing diagnosis of risk for
ineffective health maintenance related to nonadherence to therapeutic
regimen. When planning this patient’s care, what desired outcome
should the nurse identify?
A) Patient takes medication as
prescribed and reports any adverse effects.
B) Patient’s BP
remains consistently below 140/90 mm Hg.
C) Patient denies signs
and symptoms of hypertensive urgency.
D) Patient is able to
describe modifiable risk factors for hypertension.
Ans: A
Feedback:
The most appropriate expected outcome
for a patient who is given the nursing diagnosis of risk for
ineffective health maintenance is that he or she takes the medication
as prescribed. The other listed goals are valid aspects of care, but
none directly relates to the patient’s role in his or her treatment regimen.
8. The nurse is providing care for a patient with a new diagnosis of
hypertension. How can the nurse best promote the patient’s adherence
to the prescribed therapeutic regimen?
A) Screen the patient for
visual disturbances regularly.
B) Have the patient participate in
monitoring his or her own BP.
C) Emphasize the dire health
outcomes associated with inadequate BP control.
D) Encourage the
patient to lose weight and exercise regularly.
Ans: B
Feedback:
Adherence to the therapeutic regimen
increases when patients actively participate in self-care, including
self-monitoring of BP and diet. Dire warnings may motivate some
patients, but for many patients this is not an appropriate or
effective strategy. Screening for vision changes and promoting healthy
lifestyle are appropriate nursing actions, but do not necessarily
promote adherence to a therapeutic regimen.
9. A patient newly diagnosed with hypertension asks the nurse what
happens when uncontrolled hypertension is prolonged. The nurse
explains that a patient with prolonged, uncontrolled hypertension is
at risk for developing what health problem?
A) Renal
failure
B) Right ventricular hypertrophy
C) Glaucoma
D) Anemia
Ans: A
Feedback:
When uncontrolled hypertension is
prolonged, it can result in renal failure, myocardial infarction,
stroke, impaired vision, left ventricular hypertrophy, and cardiac
failure. Glaucoma and anemia are not directly associated with hypertension.
10. A patient with primary hypertension complains of dizziness with
ambulation. The patient is currently on an alpha-adrenergic blocker
and the nurse assesses characteristic signs and symptoms of postural
hypotension. When teaching this patient about risks associated with
postural hypotension, what should the nurse emphasize?
A) Rising
slowly from a lying or sitting position
B) Increasing fluids to
maintain BP
C) Stopping medication if dizziness persists
D)
Taking medication first thing in the morning
Ans: A
Feedback:
Patients who experience postural
hypotension should be taught to rise slowly from a lying or sitting
position and use a cane or walker if necessary for safety. It is not
necessary to teach these patients about increasing fluids or taking
medication in the morning (this would increase the effects of
dizziness). Patient should not be taught to stop the medication if
dizziness persists because this is unsafe and beyond the nurse’s scope
of practice.
11. The nurse is planning the care of a patient who has been
diagnosed with hypertension, but who otherwise enjoys good health.
When assessing the response to an antihypertensive drug regimen, what
blood pressure would be the goal of treatment?
A) 156/96 mm Hg or
lower
B) 140/90 mm Hg or lower
C) Average of 2 BP readings
of 150/80 mm Hg
D) 120/80 mm Hg or lower
Ans: B
Feedback:
The goal of antihypertensive drug
therapy is a BP of 140/90 mm Hg or lower. A pressure of 130/80 mm Hg
is the goal for patients with diabetes or chronic kidney disease.
12. A patient in a hypertensive emergency is admitted to the ICU. The
nurse anticipates that the patient will be treated with IV
vasodilators, and that the primary goal of treatment is what?
A)
Lower the BP to reduce onset of neurologic symptoms, such as headache
and vision changes.
B) Decrease the BP to a normal level based on
the patient’s age.
C) Decrease the mean arterial pressure between
20% and 25% in the first hour of treatment.
D) Reduce the BP to
120/75 mm Hg as quickly as possible.
Ans: C
Feedback:
Initially, the treatment goal in
hypertensive emergencies is to reduce the mean arterial pressure by
25% in the first hour of treatment, with further reduction over the
next 24 hours. Lowering the BP too fast may cause hypotension in a
patient whose body has adjusted to hypertension and could cause a
stroke, MI, or visual changes. Neurologic symptoms should be
addressed, but this is not the primary focus of treatment planning.
13. The nursing lab instructor is teaching student nurses how to take
blood pressure. To ensure accurate measurement, the lab instructor
would teach the students to avoid which of the following
actions?
A) Measuring the BP after the patient has been seated
quietly for more than 5 minutes
B) Taking the BP at least 10
minutes after nicotine or coffee ingestion
C) Using a cuff with a
bladder that encircles at least 80% of the limb
D) Using a bare
forearm supported at heart level on a firm surface
Ans: B
Feedback:
Blood pressures should be taken with the
patient seated with arm bare, supported, and at heart level. The
patient should not have smoked tobacco or taken caffeine in the 30
minutes preceding the measurement. The patient should rest quietly for
5 minutes before the reading is taken. The cuff bladder should
encircle at least 80% of the limb being measured and have a width of
at least 40% of limb circumference. Using a cuff that is too large
results in a lower BP and a cuff that is too small will give a higher
BP measurement.
14. A nurse is teaching an adult female patient about the risk
factors for hypertension. What should the nurse explain as risk
factors for primary hypertension?
A) Obesity and high intake of
sodium and saturated fat
B) Diabetes and use of oral
contraceptives
C) Metabolic syndrome and smoking
D) Renal
disease and coarctation of the aorta
Ans: A
Feedback:
Obesity, stress, high intake of sodium
or saturated fat, and family history are all risk factors for primary
hypertension. Diabetes and oral contraceptives are risk factors for
secondary hypertension. Metabolic syndrome, renal disease, and
coarctation of the aorta are causes of secondary hypertension.
15. The nurse is caring for an older adult with a diagnosis of
hypertension who is being treated with a diuretic and beta-blocker.
Which of the following should the nurse integrate into the management
of this client’s hypertension?
A) Ensure that the patient
receives a larger initial dose of antihypertensive medication due to
impaired absorption.
B) Pay close attention to hydration status
because of increased sensitivity to extracellular volume
depletion.
C) Recognize that an older adult is less likely to
adhere to his or her medication regimen than a younger
patient.
D) Carefully assess for weight loss because of impaired
kidney function resulting from normal aging.
Ans: B
Feedback:
Elderly people have impaired
cardiovascular reflexes and thus are more sensitive to extracellular
volume depletion caused by diuretics. The nurse needs to assess
hydration status, low BP, and postural hypotension carefully. Older
adults may have impaired absorption, but they do not need a higher
initial dose of an antihypertensive than a younger person. Adherence
to treatment is not necessarily linked to age. Kidney function and
absorption decline with age; less, rather than more antihypertensive
medication is prescribed. Weight gain is not necessarily indicative of
kidney function decline.
16. A patient with secondary hypertension has come into the clinic
for a routine check-up. The nurse is aware that the difference between
primary hypertension and secondary hypertension is which of the
following?
A) Secondary hypertension has a specific
cause.
B) Secondary hypertension has a more gradual onset than
primary hypertension.
C) Secondary hypertension does not cause
target organ damage.
D) Secondary hypertension does not normally
respond to antihypertensive drug therapy.
Ans: A
Feedback:
Secondary hypertension has a specific
identified cause. A cause could include narrowing of the renal
arteries, renal parenchymal disease, hyperaldosteronism, certain
medications, pregnancy, and coarctation of the aorta. Secondary
hypertension does respond to antihypertensive drug therapy and can
cause target organ damage if left untreated.
17. The nurse is assessing a patient new to the clinic. Records
brought to the clinic with the patient show the patient has
hypertension and that her current BP readings approximate the readings
from when she was first diagnosed. What contributing factor should the
nurse first explore in an effort to identify the cause of the client’s
inadequate BP control?
A) Progressive target organ damage
B)
Possibility of medication interactions
C) Lack of adherence to
prescribed drug therapy
D) Possible heavy alcohol use or use of
recreational drugs
Ans: C
Feedback:
Deviation from the therapeutic program
is a significant problem for people with hypertension and other
chronic conditions requiring lifetime management. An estimated 50% of
patients discontinue their medications within 1 year of beginning to
take them. Consequently, this is a more likely problem than substance
use, organ damage, or adverse drug interactions.
18. A patient has come to the clinic for a follow-up assessment that
will include a BP reading. To ensure an accurate reading, the nurse
should confirm that the patient has done which of the
following?
A) Tried to rest quietly for 5 minutes before the
reading is taken
B) Refrained from smoking for at least 8
hours
C) Drunk adequate fluids during the day prior
D)
Avoided drinking coffee for 12 hours before the visit
Ans: A
Feedback:
Prior to the nurse assessing the
patient’s BP, the patient should try to rest quietly for 5 minutes.
The forearm should be positioned at heart level. Caffeine products and
cigarette smoking should be avoided for at least 30 minutes prior to
the visit. Recent fluid intake is not normally relevant.
19. The nurse is providing care for a patient with a diagnosis of
hypertension. The nurse should consequently assess the patient for
signs and symptoms of which other health problem?
A)
Migraines
B) Atrial-septal defect
C) Atherosclerosis
D) Thrombocytopenia
Ans: C
Feedback:
Hypertension is both a sign and a risk
factor for atherosclerotic heart disease. It is not associated with
structural cardiac defects, low platelet levels, or migraines.
20. The nurse is developing a nursing care plan for a patient who is
being treated for hypertension. What is a measurable patient outcome
that the nurse should include?
A) Patient will reduce Na+ intake
to no more than 2.4 g daily.
B) Patient will have a stable BUN
and serum creatinine levels.
C) Patient will abstain from fat
intake and reduce calorie intake.
D) Patient will maintain a
normal body weight.
Ans: A
Feedback:
Dietary sodium intake of no more than
2.4 g sodium is recommended as a dietary lifestyle modification to
prevent and manage hypertension. Giving a specific amount of allowable
sodium intake makes this a measurable goal. None of the other listed
goals is quantifiable and measurable.
21. A patient with newly diagnosed hypertension has come to the
clinic for a follow-up visit. The patient asks the nurse why she has
to come in so often. What would be the nurse’s best response?
A)
“We do this so you don’t suffer a stroke.”
B) “We do this to
determine how your blood pressure changes throughout the day.”
C)
“We do this to see how often you should change your medication
dose.”
D) “We do this to make sure your health is stable. We’ll
then monitor it at routinely scheduled intervals.”
Ans: D
Feedback:
When hypertension is initially detected,
nursing assessment involves carefully monitoring the BP at frequent
intervals and then at routinely scheduled intervals. The reference to
stroke is frightening and does not capture the overall rationale for
the monitoring regimen. Changes throughout the day are not a clinical
priority for most patients. The patient must not change his or her
medication doses unilaterally.
22. The hospital nurse cares for many patients who have hypertension.
What nursing diagnosis is most common among patients who are being
treated for this health problem?
A) Deficient knowledge regarding
the lifestyle modifications for management of hypertension
B)
Noncompliance with therapeutic regimen related to adverse effects of
prescribed therapy
C) Deficient knowledge regarding BP
monitoring
D) Noncompliance with treatment regimen related to
medication costs
Ans: B
Feedback:
Deviation from the therapeutic program
is a significant problem for people with hypertension and other
chronic conditions requiring lifetime management. For many patients,
this is related to adverse effects of medications. Medication cost is
relevant for many patients, but adverse effects are thought to be a
more significant barrier. Many patients are aware of necessary
lifestyle modification, but do not adhere to them. Most patients are
aware of the need to monitor their BP.
23. The nurse is teaching a patient about some of the health
consequences of uncontrolled hypertension. What health problems should
the nurse describe? Select all that apply.
A) Transient ischemic
attacks
B) Cerebrovascular accident
C) Retinal
hemorrhage
D) Venous insufficiency
E) Right ventricular hypertrophy
Ans: A, B, C
Feedback:
Potential complications of
hypertension include the following: left ventricular hypertrophy; MI;
heart failure; transient ischemic attacks (TIAs); cerebrovascular
accident; renal insufficiency and failure; and retinal hemorrhage.
Venous insufficiency and right ventricular hypertrophy are not
potential complications of uncontrolled hypertension.
24. The nurse is collaborating with the dietitian and a patient with
hypertension to plan dietary modifications. These modifications should
include which of the following?
A) Reduced intake of protein and
carbohydrates
B) Increased intake of calcium and vitamin
D
C) Reduced intake of fat and sodium
D) Increased intake of
potassium, vitamin B12 and vitamin D
Ans: C
Feedback:
Lifestyle modifications usually include
restricting sodium and fat intake, increasing intake of fruits and
vegetables, and implementing regular physical activity. There is no
need to increase calcium, potassium, and vitamin intake. Calorie
restriction may be required for some patients, but a specific
reduction in protein and carbohydrates is not normally indicated.
25. The critical care nurse is caring for a patient just admitted in
a hypertensive emergency. The nurse should anticipate the
administration of what medication?
A) Warfarin (Coumadin)
B)
Furosemide (Lasix)
C) Sodium nitroprusside (Nitropress)
D)
Ramipril (Altace)
Ans: C
Feedback:
The medications of choice in
hypertensive emergencies are those that have an immediate effect. IV
vasodilators, including sodium nitroprusside (Nitropress), nicardipine
hydrochloride (Cardene), clevidipine (Cleviprex), fenoldopam mesylate
(Corlopam), enalaprilat, and nitroglycerin, have immediate actions
that are short lived (minutes to 4 hours), and they are therefore used
for initial treatment. Ramipril is administered orally and would not
meet the patient’s immediate need for BP management. Diuretics, such
as Lasix, are not used as initial treatments and there is no
indication for anticoagulants such as Coumadin.
26. A patient in hypertensive emergency is being cared for in the
ICU. The patient has become hypovolemic secondary to natriuresis. What
is the nurse’s most appropriate action?
A) Add sodium to the
patient’s IV fluid, as ordered.
B) Administer a vasoconstrictor,
as ordered.
C) Promptly cease antihypertensive therapy.
D)
Administer normal saline IV, as ordered.
Ans: D
Feedback:
If there is volume depletion secondary
to natriuresis caused by the elevated BP, then volume replacement with
normal saline can prevent large, sudden drops in BP when
antihypertensive medications are administered. Sodium administration,
cessation of antihypertensive therapy, and administration of
vasoconstrictors are not normally indicated.
27. During an adult patient’s last two office visits, the nurse
obtained BP readings of 122/84 mm Hg and 130/88 mm Hg, respectively.
How would this patient’s BP be categorized?
A) Normal
B)
Prehypertensive
C) Stage 1 hypertensive
D) Stage 2 hypertensive
Ans: B
Feedback:
Prehypertension is defined systolic BP
of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg.
28. A patient comes to the walk-in clinic complaining of frequent
headaches. While assessing the patient’s vital signs, the nurse notes
the BP is 161/101 mm Hg. According to JNC 7, how would this patient’s
BP be defined if a similar reading were obtained at a subsequent
office visit?
A) High normal
B) Normal
C) Stage 1
hypertensive
D) Stage 2 hypertensive
Ans: D
Feedback:
JNC 7 defines stage 2 hypertension as a
reading 160/100 mm Hg.
29. A patient has been diagnosed as being prehypertensive. What
should the nurse encourage this patient to do to aid in preventing a
progression to a hypertensive state?
A) Avoid excessive potassium
intake.
B) Exercise on a regular basis.
C) Eat less protein
and more vegetables.
D) Limit morning activity.
Ans: B
Feedback:
To prevent or delay progression to
hypertension and reduce risk, JNC 7 urged health care providers to
encourage people with blood pressures in the prehypertension category
to begin lifestyle modifications, such as nutritional changes and
exercise. There is no need for patients to limit their activity in the
morning or to avoid potassium and protein intake.
30. The nurse is screening a number of adults for hypertension. What
range of blood pressure is considered normal?
A) Less than 140/90
mm Hg
B) Less than 130/90 mm Hg
C) Less than 129/89 mm
Hg
D) Less than 120/80 mm Hg
Ans: D
Feedback:
JNC 7 defines a blood pressure of less
than 120/80 mm Hg as normal, 120 to 129/80 to 89 mm Hg as
prehypertension, and 140/90 mm Hg or higher as hypertension.
31. A community health nurse teaching a group of adults about
preventing and treating hypertension. The nurse should encourage these
participants to collaborate with their primary care providers and
regularly monitor which of the following?
A) Heart rate
B)
Sodium levels
C) Potassium levels
D) Blood lipid levels
Ans: D
Feedback:
Hypertension often accompanies other
risk factors for atherosclerotic heart disease, such as dyslipidemia
(abnormal blood fat levels), obesity, diabetes, metabolic syndrome,
and a sedentary lifestyle. Individuals with hypertension need to
monitor their sodium intake, but hypernatremia is not a risk factor
for hypertension. In many patients, heart rate does not correlate
closely with BP. Potassium levels do not normally relate to BP.
32. A community health nurse is planning an educational campaign
addressing hypertension. The nurse should anticipate that the
incidence and prevalence of hypertension are likely to be highest
among members of what ethnic group?
A) Pacific Islanders
B)
African Americans
C) Asian-Americans
D) Hispanics
Ans: D
Feedback:
The prevalence of uncontrolled
hypertension varies by ethnicity, with Hispanics and African Americans
having the highest prevalence at approximately 63% and 57%, respectively.
33. The home health nurse is caring for a patient who has a
comorbidity of hypertension. What assessment question most directly
addresses the possibility of worsening hypertension?
A) “Are you
eating less salt in your diet?”
B) “How is your energy level
these days?”
C) “Do you ever get chest pain when you
exercise?”
D) “Do you ever see spots in front of your eyes?”
Ans: D
Feedback:
To identify complications or worsening
hypertension, the patient is questioned about blurred vision, spots in
front of the eyes, and diminished visual acuity. The heart, nervous
system, and kidneys are also carefully assessed, but angina pain and
decreased energy are not normally suggestive of worsening
hypertension. Sodium limitation is a beneficial lifestyle
modification, but nonadherence to this is not necessarily a sign of
worsening symptoms.
34. A student nurse is taking care of an elderly patient with
hypertension during a clinical experience. The instructor asks the
student about the relationships between BP and age. What would be the
best answer by the student?
A) “Because of reduced smooth muscle
tone in blood vessels, blood pressure tends to go down with age, not
up.”
B) “Decreases in the strength of arteries and the presence
of venous insufficiency cause hypertension in the elderly.”
C)
“Structural and functional changes in the cardiovascular system that
occur with age contribute to increases in blood pressure.”
D)
“The neurologic system of older adults is less efficient at monitoring
and regulating blood pressure.”
Ans: C
Feedback:
Structural and functional changes in the
heart and blood vessels contribute to increases in BP that occur with
aging. Venous insufficiency does not cause hypertension, however.
Increased BP is not primarily a result of neurologic changes.
35. A 55-year-old patient comes to the clinic for a routine check-up.
The patient’s BP is 159/100 mm Hg and the physician diagnoses
hypertension after referring to previous readings. The patient asks
why it is important to treat hypertension. What would be the nurse’s
best response?
A) “Hypertension can cause you to develop
dangerous blood clots in your legs that can migrate to your
lungs.”
B) “Hypertension puts you at increased risk of type 1
diabetes and cancer in your age group.”
C) “Hypertension is the
leading cause of death in people your age.”
D) “Hypertension
greatly increases your risk of stroke and heart disease.”
Ans: D
Feedback:
Hypertension, particularly elevated
systolic BP, increases the risk of death, stroke, and heart failure in
people older than 50 years. Hypertension is not a direct precursor to
pulmonary emboli, and it does not put older adults at increased risk
of type 1 diabetes or cancer. It is not the leading cause of death in
people 55 years of age.
36. The nurse is reviewing the medication administration record of a
patient who takes a variety of medications for the treatment of
hypertension. What potential therapeutic benefits of antihypertensives
should the nurse identify? Select all that apply.
A) Increased
venous return
B) Decreased peripheral resistance
C)
Decreased blood volume
D) Decreased strength and rate of
myocardial contractions
E) Decreased blood viscosity
Ans: B, C, D
Feedback:
The medications used for treating
hypertension decrease peripheral resistance, blood volume, or the
strength and rate of myocardial contraction. Antihypertensive
medications do not increase venous return or decrease blood viscosity.
37. A newly diagnosed patient with hypertension is prescribed Diuril,
a thiazide diuretic. What patient education should the nurse provide
to this patient?
A) “Eat a banana every day because Diuril causes
moderate hyperkalemia.”
B) “Take over-the-counter potassium pills
because Diuril causes your kidneys to lose potassium.”
C) “Diuril
can cause low blood pressure and dizziness, especially when you get up
suddenly.”
D) “Diuril increases sodium levels in your blood, so
cut down on your salt.”
Ans: C
Feedback:
Thiazide diuretics can cause postural
hypotension, which may be potentiated by alcohol, barbiturates,
opioids, or hot weather. Diuril does not cause either moderate
hyperkalemia or severe hypokalemia and it does not result in hypernatremia.
38. A patient in hypertensive urgency is admitted to the hospital.
The nurse should be aware of what goal of treatment for a patient in
hypertensive urgency?
A) Normalizing BP within 2 hours
B)
Obtaining a BP of less than 110/70 mm Hg within 36 hours
C)
Obtaining a BP of less than 120/80 mm Hg within 36 hours
D)
Normalizing BP within 24 to 48 hours
Ans: D
Feedback:
In cases of hypertensive urgency, oral
agents can be administered with the goal of normalizing BP within 24
to 48 hours. For patients with this health problem, a BP of 120/80 mm
Hg may be unrealistic.
39. A patient’s medication regimen for the treatment of hypertension
includes hydrochlorothiazide. Following administration of this
medication, the nurse should anticipate what effect?
A)
Drowsiness or lethargy
B) Increased urine output
C)
Decreased heart rate
D) Mild agitation
Ans: B
Feedback:
Thiazide diuretics lower BP by reducing
circulating blood volume; this results in a short-term increase in
urine output. These drugs do not cause bradycardia, agitation, or drowsiness.
40. A patient’s recently elevated BP has prompted the primary care
provider to prescribe furosemide (Lasix). The nurse should closely
monitor which of the following?
A) The client’s oxygen saturation
level
B) The patient’s red blood cells, hematocrit, and
hemoglobin
C) The patient’s level of consciousness
D) The
patient’s potassium level
Ans: D
Feedback:
Loop diuretics can cause potassium
depletion. They do not normally affect level of consciousness,
erythrocytes, or oxygen saturation.